探讨对比增强乳腺X线摄影术（CESM）的强化特点及其诊断乳腺癌的价值。

回顾性分析2017年月至2019年3月在山东省泰安市中心医院就诊的138例临床怀疑乳腺肿瘤的女性患者资料，并以手术或组织活检的病理结果为参考标准，参照第5版乳腺影像报告及数据系统（BI-RADS）对乳腺肿瘤进行评估分类。统计乳腺浸润癌、原位癌及良性肿瘤的强化程度（轻、中、重度）、强化密度（均匀、不均匀）及强化方式［流入型（Ⅰ型）、平台型（Ⅱ型）、流出型（Ⅲ型）］，使用χ²检验比较3者间的差异。

138例患者共147个乳腺肿瘤，其中40个良性肿瘤，86个浸润癌，21个原位癌。96.5%（83/86）的浸润癌、42.9%（9/21）的原位癌、15.0%（6/40）的良性肿瘤表现为中、重度强化（χ²=87.878，P<0.001）。91.9%（79/86）的浸润癌、85.7%（18/21）的原位癌、73.5%（25/34）的良性肿瘤表现为不均匀强化（包括环形强化）（χ²=7.036，P=0.030）。90.7%（78/86）的浸润癌、47.6%（10/21）的原位癌、32.4%（11/34）的良性肿瘤表现出Ⅱ型、Ⅲ型强化方式（χ²=45.683，P<0.001）。中、重度强化诊断乳腺浸润癌、原位癌、良性肿瘤的敏感度分别为96.5%（83/86）、42.9%（9/21）、17.6%（6/34）；不均匀强化诊断乳腺浸润癌、原位癌、良性肿瘤的敏感度分别为91.9%（79/86）、85.7%（18/21）、73.5%（25/34）；Ⅱ型或Ⅲ型强化方式对诊断乳腺浸润癌、原位癌、良性肿瘤的敏感度分别为90.7%（78/86）、47.6%（10/21）、32.4%（11/34）。

CESM上肿块显示为中、重度强化，不均匀强化，流出型（Ⅱ型）、平台型（Ⅲ型）强化方式，对于乳腺浸润癌有较大的诊断价值。

To assess the diagnostic value of contrast-enhanced spectral mammography (CESM) features in breast carcinoma by analyzing the CESM features of benign and malignant breast tumors.

A retrospective analysis was performed on 138 female patients with clinically suspected breast tumors in Tai′an Central Hospital from July 2017 to March 2019. The breast tumors were evaluated and classified according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) standard. Based on the pathological results of surgery or biopsy, the degree (mild, moderate, and severe), density (homogeneous and heterogeneous), and pattern of enhancement (typeⅠpersistent, typeⅡplateau, and typeⅢ washout) of different tumors were statistically analyzed. The Chi-square test was applied to analyze the different features between the benign tumors group, carcinoma in situ (DCIS) group, and invasive carcinoma group.

A total of 147 breast tumors were confirmed by pathology, including 40 benign tumors, 86 invasive carcinomas, and 21 DCIS. Approximately 96.5% (83/86) of invasive carcinomas, 42.9% (9/21) of DCIS, and 15.0% (6/40) of benign tumors showed moderate or severe enhancement (χ²=87.878, P<0.001); 91.9% (79/86) of invasive carcinomas, 85.7%(18/21) of DCIS, and 73.5% (25/34) of benign tumors showed heterogeneous enhancement (including ring enhancement) (χ²=7.036, P=0.030); 90.7% (78/86) of invasive carcinomas, 47.6% (10/21) of DCIS, and 32.4% (11/34) of benign tumors showed typeⅡor Ⅲ enhancement (χ²=45.683, P<0.001). The sensitivity of moderate or severe enhancement for the diagnosis of breast invasive cancer, DCIS, and benign tumors was 96.5% (83/86), 42.9% (9/21), and 17.6% (6/34), respectively; the sensitivity of heterogeneous enhancement was 91.9%, 85.7%, and 73.5%, respectively, and the sensitivity of typeⅡorⅢ enhancement was 90.7% (79/86), 47.6% (10/21), and 32.4% (11/34), respectively.

Moderate or severe enhancement, heterogeneous enhancement, and typeⅡor Ⅲ enhancement on CESM are valuable for the diagnosis of invasive breast cancer.